Attachment 2 - Student Exit Summary
Student Exit Summary
For Students Eligible for the New York State Alternate Assessment (NYSSA) - Word 
(142 KB)
| Student: | School: | ID#: |
| Completed by: | Title: | Date: |
Student Skills, Strengths and Interests
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| Key for Levels of Independence (with the use of assistive technology and accommodations as appropriate) | |
| 1: Not Applicable | Student has not had an opportunity or been observed to attempt or complete task. |
| 2: Extensive Support | Student requires ongoing assistance (verbal, physical, visual prompts) and close supervision to complete task. |
| 3: Moderate Support | Student requires frequent assistance (verbal, physical, visual prompts) and periodic supervision to complete task. |
| 4: Minimal Support | Student requires occasional assistance (verbal, physical, visual prompts) and intermittent supervision to complete task. |
| 5: Independent | Student completes task without assistance/supervision. |
Competencies
| Career Development: Knowledgeable about the world of work, career options, personal skills, aptitudes, and abilities relating to future career decisions. | ||
| Skills/Abilities | Level of Independence | Comments |
| Exhibits and/or expresses specific interests | ||
| Demonstrates abilities related to specific interests | ||
| Demonstrates awareness of opportunities for employment and/or other post-secondary activities related to specific interests | ||
| Identifies skills needed for post-secondary success | ||
| Identifies accommodations needed for post-secondary success | ||
| Integrated Learning: Application of academic knowledge and skills to school, community, and home settings. | ||
| Skills/Abilities | Level of Independence | Comments |
| Uses basic academic skills in community/work-based learning experiences (e.g., applies math skills to purchasing items, applies alphabetizing skills to sorting mail) | ||
| Demonstrates skills learned in school in a variety of settings (e.g., home, community, workplace) | ||
| Universal Foundation Skills | ||
| Basic Skills: Ability to read, write, listen, speak and perform arithmetical and mathematical functions. | ||
| Skills/Abilities | Level of Independence | Comments |
| Reading: Identifies and understands texts and symbols (e.g., stop, exit, and restroom signs) | ||
| Reading: Identifies vocabulary associated with various jobs (e.g., matches tools to words) | ||
| Writing: Creates pictures, symbols and objects and writes words and sentences to communicate information | ||
| Listening: Follows one step directions to complete a given task | ||
| Listening: Follows two or more step directions to complete a given task | ||
| Speaking: Uses language to interact with others (e.g., expresses needs, demonstrates understanding, and interacts socially with others). May include use of augmentative communication, as appropriate. | ||
| Math: Demonstrates basic math skills, including counting with one-to-one correspondence, matching similar objects, and understanding concepts of quantity (e.g., more, less, etc.) | ||
| Functional Math: Applies basic math skills to daily living (e.g., tells time, manages money) | ||
| Thinking Skills: Ability to use ideas and information to make decisions and solve problems. | ||
| Skills/Abilities | Level of Independence | Comments |
| Recognizes that there is a problem and requests assistance | ||
| Solves routine problems in daily life (e.g., indicates choice from menu of items, dresses for the weather) | ||
| Solves less common problems, such as contacting emergency services (e.g., dial 911) | ||
| Demonstrates understanding of cause and effect (e.g., burned when touches hot stove; consequences of inappropriate behavior) | ||
| Uses similar skills across a variety of settings (e.g., identifies building exits in different settings) | ||
| Personal Qualities: Ability to self-manage, plan, organize, and take independent action. | ||
| Skills/Abilities | Level of Independence | Comments |
| Communicates preferences and needs | ||
| Self-regulates during transitions (e.g., waits appropriately, engages in appropriate self-soothing activity in stressful situations) | ||
| Transitions appropriately between activities | ||
| Manages health (e.g., makes personal and health needs known) | ||
| Performs personal care skills | ||
| Uses unstructured time appropriately | ||
| Interpersonal Skills: Ability to work independently or as part of a team and relate to different people across settings. | ||
| Skills/Abilities | Level of Independence | Comments |
| Asks for help when faced with difficult situations and individuals | ||
| Self-advocates (e.g., seeks out and uses supports and accommodations) | ||
| Accepts direction from authority figures | ||
| Works independently | ||
| Works as part of a team | ||
| Respects the space and property of others | ||
| Demonstrates appropriate behavior across settings | ||
| Interacts appropriately with peers and others | ||
| Participates in leisure/recreation activities | ||
| Technology: Ability to use different types of technology and resources to satisfy personal and societal needs and wants. | ||
| Skills/Abilities | Level of Independence | Comments |
| Identifies the correct tool/technology necessary to complete a given task | ||
| Uses basic tools safely and appropriately (e.g., microwave, eating utensils, televisions, assistive technology) | ||
| Managing Information: Ability to access and use information. | ||
| Skills/Abilities | Level of Independence | Comments |
| Uses information to make simple decisions (e.g., responds to safety alarms, follows traffic safety rules) | ||
| Accesses information from a variety of sources (e.g., internet, grocery ads, orders from a menu) | ||
| Managing Resources: Ability to apply financial and human resources and manage time and materials to successfully carry out a planned activity. | ||
| Skills/Abilities | Level of Independence | Comments |
| Selects the appropriate resources to complete a task | ||
| Initiates tasks | ||
| Remains on task | ||
| Completes tasks within existing time limits | ||
| Manages household/environmental tasks (e.g., prepares meals, cleans room, does laundry) | ||
| Systems: Ability to understand how a system operates and identify where to obtain information and resources within that system. | ||
| Skills/Abilities | Level of Independence | Comments |
| Navigates the community (e.g., walking, public transportation) | ||
| Demonstrates understanding of who to ask for help | ||
| Uses appropriate health and safety practices | ||
| Follows daily schedule and routines | ||
| Adapts to new situations | ||
| Understands and follows rules | ||
| Other Universal Foundation Skills: Additional competencies student demonstrates that support post-school living, learning and working. | ||
| Skills/Abilities | Level of Independence | Comments |
Recommendations to Assist Student to Meet Post-secondary Goals |
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| Education/Training Goal: | Employment Goal: | Independent Living Goal (if appropriate): | |
| Supports | Recommendations | ||
| Accommodations | |||
| Assistive Technology/ Adaptive Equipment |
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| Environmental Supports | |||
| Further Skill Development< | |||
| Adult Agencies Referrals/Contacts | |||
| Other | |||
Last Updated:
April 18, 2012